SAINT LOUIS UNIVERSITY
IRB
#
Institutional Review Board
Room C110 Caroline
(314) 977-7744
Fax (314) 977-7730
CODE ACCESS AGREEMENT
Principal Investigator __________________________ PI’s Phone Number ___________
Last
First
Credentials
Title of Project: __________________________________________________________
Use this agreement when SLU is receiving or sending coded research materials.
Faxed signatures are acceptable. If it is not possible to have both parties sign the exact same
form, the IRB will accept two copies of this form with the signature of the respective party on
each.

Name of Investigator Receiving Coded Material: __________________________
Address of Investigator Receiving Coded Material: ________________________

Name of Investigator Sending Coded Material: ____________________________
Address of Investigator Sending Coded Material: __________________________

To protect subject confidentiality, the recipient Investigator will not have access to PHI
identifiers or a master code list under any circumstances.
______________________________________________________________________
Signature of Investigator Receiving Coded Material
Date
______________________________________________________________________
Signature of Investigator Sending Coded Material
Date
July 7, 2003
401281647